VACHON: MAiD delayed for mental illness is good but must be permanent

The good news is that expansion of euthanasia and assisted suicide (Medical Assistance in Dying or MAiD) for those whose sole underlying condition is a mental disorder is now being delayed for a second time.The federal government’s decision to delay came just after a parliamentary committee issued its report, which concluded that “the medical system in Canada is not prepared” for this expansion and recommended delay. Minister of Health Mark Holland has also indicated that all provinces requested an indefinite pause.The bad news is, Minister Holland has already rejected the idea of an indefinite pause.This expansion has had a curious history. When MAiD was expanded for those whose deaths were not “reasonably foreseeable” in 2021, MAiD for mental disorders as a sole underlying condition was specifically excluded by the government in its legislation. It was an amendment from the Senate that added expansion for mental disorders to the bill, which the government subsequently accepted.Expansion of MAiD for mental disorders, however, had a sunset clause resulting in this expansion not coming into effect until March 17 2023. The ostensible purpose of this time delay was providing time for healthcare systems and personnel to prepare. (Which raises the question of why expanding euthanasia eligibility for those without a reasonably foreseeable death — so called Track 2 MAiD — which has been widely criticized by disability advocates, wasn’t given the same preparation period?)Yet, under pressure, the government delayed the expansion last winter, and has now, again, this winter. It is still clearly on the government’s agenda, as statements from Minister Holland confirm. It shouldn’t be.For one, Canadians are not on board. As fall 2023 polling by the Angus Reid Institute and Cardus found, only 28% of Canadian supported this expansion, whereas 82% believed mental health care should be improved first, before expansion. If the government was looking for consensus, here it is. Indeed, this polling highlighted the barriers that many Canadians experience when it comes to accessing mental health services.For another, the mental health community is not on board. Witnesses to the special parliamentary committee spoke to the concerns from leaders within the psychiatry community, emphasizing the inherent difficulty in determining what constitutes “irremediability” within mental illness — which is a condition for eligibility — as well as in differentiating between suicidal ideation due to mental illness and a “reasoned” request for MAiD. The Ontario Psychiatric Association recently released the results of a national survey of psychiatrists and psychiatry residents, finding a majority opposed to expansion.As Cardus indicated in its own brief to the special committee, not only are there existing and inherent problems with reporting and oversight in the current provision of euthanasia, further expansion would be irresponsible given the existing barriers and gaps in mental health care. And while the government has spoken to the particular challenges that indigenous peoples face due to mental illness and the need to address the high rates of suicide in these communities, a consultation process with indigenous communities on MAiD began this past summer and will only release its results in 2025. It is unclear as to how expansion of euthanasia for mental disorders could have been allowed to expand prior to understanding its potential effects on particular populations.So, the delay must become permanent for euthanasia for mental disorders as a sole underlying condition. Instead, the government must commit to the measures that help Canadians live with dignity, including ensuring universally available, high-quality palliative care, accessible mental health care and addressing needs such as housing and supports for those with physical disabilities and mental disorders.Rebecca Vachon is Program Director for Cardus Health

VACHON: MAiD delayed for mental illness is good but must be permanent

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